Provider Demographics
NPI:1003142878
Name:KELLI BIEL-KAUTZ OCCUPATIONAL THERAPY LLC
Entity Type:Organization
Organization Name:KELLI BIEL-KAUTZ OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEL-KAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:719-265-2515
Mailing Address - Street 1:2656 THRUSH GRV
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5909
Mailing Address - Country:US
Mailing Address - Phone:719-265-2515
Mailing Address - Fax:866-586-4505
Practice Address - Street 1:2656 THRUSH GRV
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5909
Practice Address - Country:US
Practice Address - Phone:719-265-2515
Practice Address - Fax:866-586-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO978949225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18357784Medicaid